Rebecca Baer Inc.
13316 Marsh Pike
Hagerstown, MD 21742-2573
Phone: (301) 797-1300

Name_______________________________________________ Date__________________________
Street Address________________________________________________________________________
City/State/Zip__________________________________________ Country________________________
E-Mail______________________________________________ Phone /Fax:_____________________

Please mail order form with payment if you opt not to use the shopping cart.
     Quantity    

                                Item Description                                            

  Unit Price     Total    
       
       
       
       
       
       
       
       
       
       
 

Maryland residents please add 6% sales tax

   
__ MasterCard __ Visa __ __ __ __ - __ __ __ __ - __ __ __ __ - __ __ __ __
Sub Total  
Expiration Date ____ - ______ Name on card __________________________
Sign Here ______________________________________________________
Shipping  
Grand Total  
Prices are subject to change without notice